Editor’s Note: In May 2026, the Endocrine Society and other international experts officially renamed polycystic ovary syndrome (PCOS) polyendocrine metabolic ovarian syndrome (PMOS). This change better reflects the condition’s nature as a systemic metabolic disorder. This article has been updated to reflect the new terminology.
Polyendocrine metabolic ovarian syndrome — formerly known as polycystic ovary syndrome, or PCOS — is very common in women with diabetes, adding another challenge to diabetes management.
“While the degree of this increased risk varied across individual studies, the overall picture strongly suggests that people with these conditions may be more likely to experience events like heart disease or stroke,” says study coauthor Mathew Leonardi, MD, PhD, an associate professor of obstetrics and gynecology at McMaster University in Ontario, Canada.
Endometriosis and PMOS Pose the Greatest Risk to Heart and Brain Health
Compared with women without gynecologic disorders, researchers concluded that those who had at least one gynecologic disorder had:
- 28 percent higher risk of cardiovascular and cerebrovascular disease
- 41 percent higher risk of ischemic heart disease (heart damage caused by narrowed heart arteries)
- 33 percent higher risk of cerebrovascular disease, including conditions such as stroke, brain aneurysm, brain bleed, and carotid artery disease
Women with PMOS, endometriosis, or both faced the highest overall risk.
Endometriosis is when tissue similar to the lining of the uterus grows outside of the uterus. The condition may affect as many as 1 in 9 girls and women in the United States between the ages of 15 and 44. It is especially common in women in their thirties and forties.
It’s possible for women to have both endometriosis and PMOS.
Analysis Highlights Lack of Quality Research on Gynecologic Health
Researchers acknowledged that the overall quality of the studies included in the analysis varied considerably, and they scored more than half of the studies as having a very high risk of bias.
“Another key takeaway is the need for better, more consistent research — many of the studies we included had limitations. Still, taken together, the data point to a relationship worth paying attention to in both clinical practice and future research,” says Dr. Leonardi.
Abha Khandelwal, MD, a clinical professor of medicine and women’s heart health specialist at Stanford Medicine in California, also points out the need for better research in this area. Dr. Khandelwal wasn’t involved in the study.
“Only 21 percent of the reviewed studies had good design and low risk of bias, several of the reviewed studies had bias, and there are likely several confounders which were not adjusted for,” she says.
This means that those studies didn’t control for other key factors that could influence the risk of heart disease and stroke.
“In order for science to move forward and to understand all the associations and potentially modifiable risk factors for women, it is critical to fund good quality research in this field and for women to participate in these studies. I hope this will serve as a call to action for women to advocate for better research in these areas and for them to continue to work on controlling their risk factors for heart disease and cerebrovascular disease,” says Khandelwal.
What Could Be Behind the Link?
The analysis wasn’t set up to uncover a potential “why.” Based on the diseases, and not on the study findings, there could be a few potential connections, says Khandelwal, such as:
- PMOS and cerebrovascular disease have similar inflammatory pathways and risk factors.
- There are several ways that these gynecologic conditions may interfere with a heart-healthy lifestyle. For example, if you have severe period pain, you may be less inclined to exercise.
- If you have irregular cycles, it may be due to variations in your sex hormones. “We know this can influence endothelial cell function,” Khandelwal says. Endothelial cells line the inside of blood vessels and help regulate blood flow.
“We also can’t overlook treatments and surgeries used to treat these gynecological conditions. For instance, certain hormonal therapies or procedures like hysterectomy may themselves influence the long-term risk of heart disease and stroke,” says Leonardi.
How Should Women With PMOS and Endometriosis Manage Potential Increased Risk?
Leonardi emphasizes that although these findings suggest a link, it’s not “ironclad proof of a direct cause-and-effect relationship,” and more research is needed.
“If you have a gynecological condition, it doesn’t mean you’re destined to develop heart or cerebrovascular disease — just that it’s wise to pay extra attention. The message here is about being proactive but not alarmed,” says Leonardi.
He offers the following tips:
- Talk to your healthcare team about cardiovascular risk factors. Ask about your blood pressure, cholesterol, and blood sugar levels, especially if you have PMOS, endometriosis, or other chronic gynecologic conditions.
- Adopt healthy lifestyle habits, such as staying physically active, eating a balanced diet, and avoiding smoking.
- If you’re on hormonal treatments, or if you’ve had surgeries like a hysterectomy or oophorectomy (ovary removal), be sure to review these factors with your providers to assess how they might interact with your cardiovascular health.
“If possible, participate in trials to advance further understanding of these disease processes,” says Khandelwal.
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